CN103747758A - Laser catheter for bypass surgery, as well as assembly comprising such a catheter - Google Patents
Laser catheter for bypass surgery, as well as assembly comprising such a catheter Download PDFInfo
- Publication number
- CN103747758A CN103747758A CN201180072998.0A CN201180072998A CN103747758A CN 103747758 A CN103747758 A CN 103747758A CN 201180072998 A CN201180072998 A CN 201180072998A CN 103747758 A CN103747758 A CN 103747758A
- Authority
- CN
- China
- Prior art keywords
- laser catheter
- aperture plate
- narrowing portion
- vascular
- plate element
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Pending
Links
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
- A61B2218/007—Aspiration
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T29/00—Metal working
- Y10T29/49—Method of mechanical manufacture
- Y10T29/49826—Assembling or joining
Landscapes
- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Physics & Mathematics (AREA)
- Public Health (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- General Health & Medical Sciences (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- Otolaryngology (AREA)
- Optics & Photonics (AREA)
- Electromagnetism (AREA)
- Media Introduction/Drainage Providing Device (AREA)
- Laser Surgery Devices (AREA)
- Prostheses (AREA)
Abstract
The invention relates to a laser catheter for bypass surgery. The laser catheter comprises: a tubular arrangement comprising a tubular bundle of optical fibres having distal ends defining an emitting surface for emitting laser radiation in the distal direction of the catheter; at the distal end of the catheter, a channel extending in axial direction of the catheter and defined by the inside of the tubular arrangement, which channel is connectable to a suction source; and a grid element arranged inside the channel at a distance proximally from the emitting surface, which grid extends in transverse direction of the catheter across the channel. The laser catheter further comprises a narrowing arranged inside the channel and, viewed in axial direction of the catheter, between the emitting surface and the grid.
Description
Technical field
The present invention relates to the laser catheter for by-pass operation, wherein this laser catheter comprises: comprise the tubulose layout of the optical fiber tubulose bundle with the far-end that limits emitting surface, described emitting surface is for Emission Lasers radiation in the distal direction of described conduit; At the far-end of described conduit, the passage that the inside that extends upward and arranged by described tubulose at the axle of described conduit limits, described passage can be connected to suction source; With to be adjacent to described emitting surface certain distance, be arranged on the aperture plate element of described channel interior, described aperture plate element is being crossed over the extension in a lateral direction of the conduit of described passage.The invention still further relates to molectron, described molectron comprises on the one hand a kind of like this conduit and comprises on the other hand ring element and/or transplant vascular and/or suction source and/or excimer laser source.According to laser catheter of the present invention and molectron according to the present invention, can be used for the what is called being described below
operating technology.
Background technology
From EP750,476 become known for the laser catheter of by-pass operation.This paper describes that laser catheter exists
purposes in (the non-inaccessible anastomosis that excimer laser is auxiliary) operating technology.For this technology, need conduit and ring, it is called jointly
arteriotomy system.
EP750, disclosed conduit is for carrying out ETS-anastomosis (ETS=end to side) transplanting between vascular and target vascular in 476.According to
operating technology, is fixed to graft the side of target vascular with one end, simultaneously through also referred to as do not interrupted by the blood flow of the target vascular of body vessel, blood continues to flow through target vascular and carries out arteriotomy simultaneously and create identical.For this purpose, first transplanting vascular is fixed to target vascular, subsequently, after this fixing foundation, by removing a part for the wall that is positioned at the target vascular before the stiff end of transplanting vascular, forms target vascular and transplant the mobile connection between vascular.According to
operating technology, one side is by means of the fibre-optic tubulose layout of the tubulose bundle of Emission Lasers bundle, and described laser beam sources, from described fiber, is arranged the inner suction fixture providing by means of fibre-optic tubulose on the other hand, removes the described part of target blood vessel wall.The tubulose bundle of laser beam burns out annular incision in target blood vessel wall, produces the passage based on ring, and it connects the inner chamber of transplanting vascular and target vascular.The wall Bu Fen – based on ring of target vascular, is positioned at the part of described cauterization loop inside, and described part is also referred to as " lobe "-by suction fixture clamping and along with the withdrawal of conduit, remove together after burning operation.
In order to allow that the tubulose bundle of laser beam burns out annular incision in target blood vessel wall, laser catheter first must be inserted into the near-end of transplanting vascular and it must be by transplanting vascular until the far-end of described transplanting vascular subsequently.
When cutting, surgeon cannot see the position of annular incision.By transplanting the conduit of vascular insertion, hinder surgeon for the observation of annular incision position.Whether thereby surgeon cannot see whether otch completes completely separated with target vascular with lobe.In the situation that lobe is completely not separated, when regaining conduit from transplanting vascular, lobe will and can not be removed by fixture.Residual lobe or residual lobe part can cause serious problems to patient.In the situation that lobe is not removed by fixture, surgeon may have to carry out further operation to remove lobe later.Therefore, importantly, the chance that lobe is not removed by fixture is reduced to minimum, or is differently expressed as, and importantly guarantees when regaining conduit large as far as possible by the reliability of the actual lobe removing of fixture.In this respect, find out that good dissection and good holding action are important.In practice, find out that lobe removal rate is about 85%, that is, and in 85 in 100 examples, when lobe when transplanting vascular and regain conduit is correctly clamped and removes with fixture.
Summary of the invention
Catalogue of the present invention be to provide the improved laser catheter according to the preorder of claim 1 and the improved molectron that comprises described laser catheter and ring element.Object more specifically of the present invention is to provide the lobe removal rate allow improving and/or allows improved holding action and/or allow the laser catheter of improved dissection.
[cl1] realizes above-mentioned catalogue according to the present invention by being provided for the laser catheter of by-pass operation, wherein said laser catheter comprises: comprise the tubulose layout of the optical fiber tubulose bundle with the far-end that limits emitting surface, described emitting surface is for Emission Lasers radiation in the distal direction of described conduit; At the far-end of described conduit, the passage that the inside that extends upward and arranged by described tubulose at the axle of described conduit limits, described passage can be connected to suction source; With to be adjacent to described emitting surface certain distance, be arranged on the aperture plate element of described channel interior, described aperture plate is being crossed over the extension in a lateral direction of the conduit of described passage; Described laser catheter is characterised in that, described laser catheter also comprises the narrowing portion that is arranged on described channel interior, and described conduit axially on while observing, described narrowing portion is between described emitting surface and described aperture plate element; The internal diameter of described narrowing portion is less than the external diameter of described aperture plate element, and the section of the passage extending between described narrowing portion and described aperture plate element has the diameter of the internal diameter that is greater than narrowing portion.Applicant has been found that the position between aperture plate element and emitting surface is attached at the narrowing portion that leads to the channel interior that tubulose arranges and has increased so-called lobe rate.This narrowing portion can be by arranging that at tubulose inside provides ring or pipe to obtain.It is to say that this ring or pipe form like this, the inward flange of the inwall extension of arranging from tubulose on inward direction radially.Passage axially on while observing, this inward flange passes through surface-limited in flange level by passage.The improvement of lobe rate is unexpected and applicant can not determine the explanation to it.Obviously, in some way, by narrowing portion, clamping and/or cutting action have been improved.Improve holding action and may contribute to improve lobe rate, because more firm clamping allows some not tear while completing completely with the ring with laser burn, lobe and target blood vessel wall are separated.Improve holding action and can also further contribute to improve lobe rate, because more firm clamping has reduced the risk that while removing conduit from transplanting vascular after burning action, lobe departs from from fixture.The fact is, experiment shows, provide described narrowing portion to allow lobe rate from approximately 85% (without narrowing portion), to bring up to the scope (for dissimilar narrowing portion) of 90-98%, and only by increasing suction force, improve holding action, do not provide similar lobe rate to improve.
The section of the passage extending between narrowing portion and aperture plate element with the diameter of the internal diameter that is greater than narrowing portion allows that lobe keeps being free on the inwall that tubulose is arranged in described section.
Term " lobe rate " is a kind of success rate." lobe rate " is defined as the % that fetches for the successful lobe of arteriotomy of certain limit (described in fetch can be on being applied in human or animal time obtain with laboratory test or practical experience).When arteriotomy is postoperative and successfully fetch lobe when graft is regained laser catheter, the lobe of disengaging can be on laser catheter or among find.Usually, lobe will find under the condition of being fixed by fixture.
About the invention of describing in the application, it should be noted that term diameter and do not mean that it is circular, it can be avette, oval, square, hexagon etc.For example, with respect to the diameter of narrowing portion, the cross section of the passage by narrowing portion can be circular, but it can be also avette, oval, square, hexagon etc.Term diameter refers to the size of another part of in the direction transverse to passage path or conduit.
According to the present invention, aperture plate element is across the whole cross section of passage and has the element of axial passageway, and it allows suction force to be delivered to from the nearside of aperture plate element the distally of aperture plate element.A kind of like this example of aperture plate element is the plate with one or more axial hole or other axial passageway, the parallel bar betwixt in a large number with slit, net, grid grizzly bar etc.The function of aperture plate is to prevent that lobe from being inhaled aperture plate element and entering into tubulose layout, because whether this will hinder checking lobe correctly to be removed with this may cause the obstruction of suction system on the other hand on the one hand.
[cl2] according in another embodiment of the invention, extends and the described section of passage that its diameter is greater than the internal diameter of narrowing portion extends until aperture plate element from narrowing portion between narrowing portion and aperture plate element.Test shows, this structure provides improved lobe rate, may be because the holding action of the improvement of fixture.
[cl3-5], according to further embodiment, is divided into interior section and exterior section by aperture plate element; The exterior section of wherein said aperture plate element is defined as when conductive pipe far-end in proximal direction is observed by the overlapping part of narrowing portion (in other words, being arranged in the shade of narrowing portion); And the interior section of wherein said aperture plate element is defined as the overlapping part (in other words, not being arranged in the shade of narrowing portion and passing through described path visible) of path that is passed described narrowing portion when conductive pipe far-end in proximal direction is observed.Effectively, this means, the surface of the interior section of aperture plate element has the size identical with the surface of path by narrowing portion.In the present embodiment, grid hole can be arranged in the interior section and/or exterior section of aperture plate element.Grid hole is arranged in exterior section and guarantees that at any time suction force is all delivered in the space of the distal side of aperture plate element from the nearside of aperture plate element, because be not that the lobe by facing to the suction of aperture plate element is sealed in whole grid hole in the exterior section of aperture plate element.At least some grid holes will be free on lobe at any time, even at lobe not exclusively or completely from the separation of target vascular in the situation that.Grid hole is arranged on and in interior section, allows the middle body of lobe to be sucked partly contact with aperture plate.The lobe narrowing portion that tightly reclines thus, and keep suction force from the interior section of aperture plate.
[cl6-7], according to further embodiment, the inward flange of narrowing portion can be provided with tip pin, and as tip sawtooth, described tip pin is radially extending on inward direction.Tip pin has strengthened grasping on lobe.Suction force is tending towards one or more the penetrating in lobe in these tip pins.This it seems the further lobe rate that improved.According to further embodiment, these tip pins, the tip of these pins at least, can point to direction towards aperture plate so that agnail to be provided, and prevents from removing from fixture at distal direction epivalve.
[cl8-19] according to further embodiment of the present invention, the position of narrowing portion and or size can be appointed as:
The internal diameter of-narrowing portion is at the most 80% of channel diameter, for example at the most 70% or at the most 60%; Experiment test shows, from the internal diameter of narrowing portion be less than channel diameter 80%, the raising of lobe rate is obviously perceptible, and from being less than 70-60%, the raising of lobe rate is significant; And/or
The internal diameter of-narrowing portion is at least 30% of channel diameter, such as at least 40% or at least 45%; Experiment test shows, from the internal diameter of narrowing portion be greater than channel diameter 30%, the raising of lobe rate is still obviously perceptible, and from being greater than 40-45%, the raising of lobe rate is still significantly; And/or
The internal diameter of-narrowing portion is in 30% to 80% scope of channel diameter, in the scope 40% to 60%; Experiment test shows, for the narrowing portion with the internal diameter in 30% to 80% scope of channel diameter, it is perceptible well that lobe rate is improved, and this improvement is significant in 40% to 60% scope;
And/or
-while observing in the axial direction, the distance from narrowing portion to emitting surface is in 0% to 60% scope of the distance from aperture plate element to emitting surface, in the scope 20% to 45%;
-while observing in the axial direction, the axial length of narrowing portion is in 25% to 50% scope of the distance from aperture plate element to emitting surface, in the scope 35% to 40%; This axial length can for example equal from aperture plate element to 37.5% of emitting surface distance;
-while observing in the axial direction, the distance from described narrowing portion to emitting surface in 0% to 15% scope of emitting surface internal diameter, for example 4% to 12%;
And/or
-while observing in the axial direction, the distance from narrowing portion to emitting surface is at least 0.07mm, as 0.10mm at least;
And/or
-while observing in the axial direction, the distance from narrowing portion to emitting surface is at most 0.4mm, such as being at most 0.25mm;
And/or
-while observing in the axial direction, the distance from aperture plate element to emitting surface is at least 0.25 millimeter, for example, be at least 0.35 millimeter;
And/or
-while observing in the axial direction, the distance from aperture plate element to emitting surface is 0.6mm at the most, such as 0.5mm at the most;
And/or
-while observing in the axial direction, the distance from aperture plate element to narrowing portion is 0.04mm at least, such as 0.08mm at least;
And/or
-while observing in the axial direction, the distance from aperture plate element to narrowing portion is 0.5mm at the most, such as 0.4mm or at the most 0.3mm at the most.
[cl.20], according to further embodiment, laser catheter also comprises, at the far-end of conduit with on the outside of tubulose layout, with respect to fibre bundle, expands the stop element of the circumference of conduit.
[cl21-31], according to further aspect, the present invention relates to molectron, and described molectron comprises on the one hand according to laser catheter of the present invention and comprises on the other hand one or more from following group:
Ring element, the diameter of wherein said ring element is greater than the diameter of the far-end of tubulose layout;
Have and allow laser catheter by transplanting the transplanting vascular of the diameter dimension of vascular; One end of wherein said transplanting vascular can be inserted by ring element according to further embodiment and in around the turn back angle of 90-180 degree scope of ring element;
Suction source, it can connect or be connected to passage;
Excimer laser source, it can be coupled to laser catheter, for the laser energy that lasing light emitter is produced, transmits the optical fiber that enters into laser catheter.
[cl25-27] the present invention transplanting vascular used can be artificial transplanting vascular or biological implantation vascular.According to the present invention, transplant vascular and also can be made by the combination of biological and artificial material.The in the situation that of biological vascular, it should be noted that this can be derived from human or animal for body – rather than patient itself-, but it also can be derived from patient itself, as the saphena from shank or from the IMA of chest.According to the present invention, transplanting vascular can be also the vascular with the cellular layer of the biological culture that grows into stay pipe, as armour or gauze structure.
In addition, it should be pointed out that according to molectron of the present invention, in the situation that be derived from patient's self transplanting vascular, also can be completely in the outside preparation of patient, even if be connected to never in any form patient.According to molectron of the present invention, certainly can in operating room, patient self, make at one's side at intra-operative, but it also can away from patient intra-operative or before in laboratory, factory or other suitable facility, carry out.Therefore, this preparation can occur in the place that does not wherein have patient, but it also can approach patient's generation in operating room.
Transplanting vascular therefore can be separated from human body or animal body.Term used " from the transplanting vascular of human body or animal body separation " refers to term " from the separated transplanting vascular of patient's health " in this application, and transplanting vascular is the corpus separatum that is not connected to human body/animal body/patient body.Certainly, these terms are not got rid of someone and it can be remained in hands or handles it.These terms represent, when separation, graft is not the part of biosystem for people/animal/patient's health.
[cl32-33] is according to further aspect, the present invention relates to manufacture the method for the laser catheter of by-pass operation, described laser catheter comprises: comprise the tubulose layout of the optical fiber tubulose bundle with the far-end that limits emitting surface, described emitting surface is for Emission Lasers radiation in the distal direction of described conduit; At the far-end of described conduit, the passage that the inside that extends upward and arranged by described tubulose at the axle of described laser catheter limits, described passage can be connected to suction source; With to be adjacent to described emitting surface certain distance, be arranged on the aperture plate element of described channel interior, described aperture plate element is being crossed over the extension in a lateral direction of the conduit of described passage; Wherein said method comprises, described conduit axially on while observing, between described emitting surface and described aperture plate element, the step of the narrowing portion of channel interior is set.Can described narrowing portion be set according to one or more in claim 2-20.
[cl34] basis is aspect further, the present invention relates to transplanting vascular to be connected to the method for target vascular, said method comprising the steps of:
The far-end of described transplanting vascular is connected to the sidewall of target vascular;
Laser catheter according to the present invention is inserted in the inner chamber of transplanting vascular;
After described Connection Step, with described laser catheter, on the sidewall of target vascular, burn annular opening;
Described burn step during and after, by the described passage of laser catheter is applied to suction force, clamp lobe, described lobe is defined as the wall part of the target vascular that is positioned at the annular opening inside of being burnt; With
When continuing described clamping step and described burn step after, by regaining described laser catheter in the proximal direction at described transplanting vascular, from described transplanting vascular, remove described laser catheter.
Accompanying drawing explanation
In the accompanying drawings, Fig. 1-5 all show that prior art is so that backgrounds more of the present invention to be described, and Fig. 6-10 diagram the present invention.
Fig. 1 a and Fig. 1 b schematically show the laser catheter of prior art, and it can be used for
operating technology; Figure 1A is that vertical section and Figure 1B are according to the end-view of arrow lb in Figure 1A;
Fig. 2 a, Fig. 2 b, Fig. 2 c and Fig. 2 d show use
operating technology is implemented the preparatory measure of by-pass operation;
Fig. 3 a, Fig. 3 b and Fig. 3 c are presented at graft are connected to the schematically showing of different step that is subject to body vessel;
Fig. 4 a, Fig. 4 b and Fig. 4 c illustrate the model of action of catheter tip during light applies;
Fig. 5 a and Fig. 5 b show by means of conduit and remove the separating part of blood vessel wall-also referred to as lobe;
Fig. 6 schematically and with perspective view shows, according to the vertical section of the far-end of the laser catheter of first embodiment of the invention;
Fig. 7 schematically and with perspective view shows, according to the far-end of the laser catheter of second embodiment of the invention; Wherein, Fig. 7 A shows that vertical section and Fig. 7 B show perspective view;
Fig. 8 schematically shows according to the far-end of the laser catheter of third embodiment of the invention; Wherein, Fig. 8 A shows that with perspective view vertical section and Fig. 8 B show according to the arrow VIII-b in Fig. 8 A according to the view on the far-end of the laser catheter of Fig. 8 A;
The laser catheter that Fig. 9 A and Fig. 9 B highly schematically explain prior art for
holding action during technology;
Figure 10 A, Figure 10 B and Figure 10 C highly schematically explain the holding action according to laser catheter of the present invention.
The specific embodiment
Fig. 1 a and Fig. 1 b show vertical section and the bottom view of the distal region 23 of laser catheter 1.Laser catheter 1 has shell 2, and it meets the typical requirement of using in medical field, as is easy to sterilization, high-flexibility and material compatibility.Shell 2 is around the tubulose bundle of optical fiber 3, and described tubulose bundle, with two-layer setting, is two concentric circulars in preferred embodiments.The near-end of optical fiber 3 21 is connected in such a way or can be connected to laser generator 4, described mode makes the laser emission (laser) being produced by laser generator can be sent to optical fiber 3, described fiber subsequently by guided laser energy from nearside fibre end 21 to distally fibre end 22.In tubular shell 5 around hole 6, it is connected to low pressure source 7 at its near-end 20.Distal region at laser catheter 1 is that excircle is widened element 8, and it has annular cross section, towards the smooth stop surface 25 of the direction of far-end.The size that excircle is widened element 8 is generally such, and the excircle of element that makes to widen the excircle of laser catheter 1 at least has the diameter that laser catheter will be conducted through vascular wherein.Like this, guaranteed that catheter tip is positioned at vascular central interior in bootstrap mode by being placed in its circumference on the interior zone of vascular.
In the direction of the far-end 24 of laser catheter, the tubulose bundle of optical fiber 3 is given prominence to and is being widened beyond the plane of element 8.Optical fiber 3 its parts are around holding device 9, and it represents the termination of inner shell 5 at far-end, but it is provided for the holding device of fixture 10 especially, and it comprises porous member 11, and this porous member 11 causes low pressure to be preponderated 6 inside in hole.Hole 6 extends to the far-end of optical fiber 3.Referring to Figure 1A and Figure 1B, porous member is the plate 14 that is provided with piercing hole 15 according to favourable layout, also referred to as aperture plate 12.In addition, Fig. 1 b shows the circumferential area of the element 8 of the excircle of widening fiber 3.
The optical fiber that laser catheter preferably has a dense arrangement to be to form flat circle with its far-end, and its external diameter is, for example, and about 2mm.The far-end 22 of optical fiber 3 limits annular emitting surface 13, and it is for Emission Lasers radiation on the distal direction P at conduit 1.Annular emitting surface 13 is generally circular, but also can have ellipse, rectangle or other annular shape.At whole optical fibers simultaneously Emission Lasers energy in the situation that, by the tubulose bundle of Emission Lasers energy/light.In embodiment as shown in Figure 2 B, there are fibre-optic 2 concentric rings 4, each ring comprise be arranged in parallel and a large amount of optical fibers that side direction adjoins each other to obtain compact texture.
In order to describe and to use laser as shown in Figure 1 more closely, Fig. 2 to Fig. 5 schematically diagram applies it to carry out the mode of by-pass operation, according to
technology, and do not interrupt taking the blood flow in hemophoric vascular.
Fig. 2 a has shown the laser catheter identical with Fig. 1 substantially, and in diagrammatic horizontal more.On this conduit, show ring-type element 16, its diameter is greater than the external diameter of fibre-optic tubulose bundle and is less than the diameter (or measure-alike) of the element 8 of the excircle of widening laser catheter.As known from prior art, the internal diameter of ring (for example, being made by the compatible platinum-iridium alloy of health or pure platinum) can be approximately 2.6 to 2.8mm.
In the preparation of by-pass operation, to encircle and transplant vascular 17-also referred to as graft-upper slip, described transplanting vascular is taken from the zones of different of patient body, make this type of as connecting for taking the surgery of the vascular removing (such as one section of tremulous pulse) of the bypass of hemophoric vascular, not complicated by the repulsion of health self or prevention.Graft also can be taken from another person or animal.Alternatively, transplanting vascular 17 can be artificial vascular, rather than takes from patient, animal or other people confession body vessel.
According to Fig. 2 b, subsequently transplanting vascular is around turned up at ring.For this purpose, can in transplanting vascular, do otch 26.The end of the transplanting vascular turning back around ring facing to transplanting vascular is sewed up in the mode shown in Fig. 2 c and 2d subsequently.The stable end of the vascular obtaining according to Fig. 2 d by this way, presents the outline of ring 16 with stable form.
Then, by thus preparation transplanting vascular 17 by means of cycling suturing join to be subject to body vessel 18-also referred to as target vascular-outer surface, as shown in Fig. 3 a.According in the state of Fig. 3 b, transplant vascular 17 and firmly lean against on the surface that is subject to body vessel 18.Then, in the direction of the blood vessel wall 27 of target vascular 18, guided laser conduit is by transplanting the inside of vascular 17, and the part 19 of blood vessel wall 27 is waited to cut off.As Fig. 3 c shows, due to ring 16, the part 19 of blood vessel wall 27 is in the region that is arranged in the profile inside of ring 16, make tension for connecting graft, make by this way the far-end of laser catheter be placed on plane domain.This advantage having is, in applying the process of laser energy, chamber wall part 19 evenly to be clashed into laser in the region contacting with annular emitting surface 13 (far-end 22 by laser fibers 3 forms).
Fig. 4 a shows the connection of transplanting vascular 17 and target vascular 18 and the perspective view that laser catheter passes through the entrance of transplanting vascular 17.The far-end of laser catheter, as shown at Fig. 4 b, first guides by vascular 17 until the emitting surface 13 of laser catheter leans against in the part 19 of blood vessel wall 27, and described part 19 is to be separated and also referred to as " lobe ".The low pressure source 7 that be connected to hole 6 started and guarantee suction that to be separated lobe 19 use by low pressure source 7 produced be extracted into fixture 10 thereafter.
Now laser generator 4 is started to (in this application, being preferred for producing the excimer laser of ultraviolet radiation).Laser can be with pulse operation, and repetition rate is for example 40Hz, and approximately 5 seconds, so that approximately 200 impulse actions are to tissue.Thereby the far-end of laser catheter is slowly through the inner chamber of target vascular 18, until ring 16 prevents from widening the stop edge 25 of element 8-and therefore laser catheter-no longer further enter inner chamber of target vascular.Therefore,, as shown in Fig. 4 c, by the blood vessel wall 19-lobe of described section-from all the other wall 27 separation of vascular 18, and be attached on the surface of fixture 10.
According to Fig. 5 a and Fig. 5 b, now the far-end of laser catheter with together with separated lobe 19 from after transplanting vascular 17 and removing, blood can flow through transplants vascular 17.The ring 16 bypass junctions that remain between vascular 17 and 18.
By means of this ELANA technology, can carry out by-pass operation, in blood vessel to be treated, create the hole limiting completely, and by mistake do not pierce through vascular and do not block by the blood flow of target vascular and do not remove the pressure in target vascular.Above-mentioned
technology and the present invention that will describe below can be applied to the vascular in any health, especially for the by-pass operation on vascular in brain and on the crown vascular of heart.
In superincumbent explanation, ring-type element 16 is the parts that are only comprised of a ring element.As directed ring-type element 16 does not have projection or other extra member.Yet, notice that other embodiment of ring-type element is also known maybe can imagining.For example, other embodiment of ring-type element 16 can find in WO2009/123434 and PCT/NL2010/050778.According to the loop member of these WO2009/123434 and PCT/NL2010/050778, there are two pins that are inserted into the almost parallel in target vascular, to the molectron of transplanting vascular and loop member is attached on the wall of target vascular.As the stitching showing in Fig. 3 a-3c can have redundantly according to the loop member of WO2009/123434 or PCT/NL2010/050778.Further use according to the loop member of WO2009/123434 or PCT/NL2010/050778, usually make two or more otch 26 (seeing Fig. 2 B) and can not use the stitching as shown in Fig. 2 C.In addition, the lobe forming between cutting flatly can be glued together, bonding or be attached in addition the wall (for example,, as shown in Fig. 8 C of WO2009/123434) that is subject to body vessel.The present invention can with all these variants and other variant applied in any combination of not describing.
The Reference numeral that the prior art laser catheter of relevant Fig. 1-5 is used is also used in Fig. 6-8, indicates similar or identical parts.Because these are illustrated, this will not repeat.With reference to the laser catheter of the present invention as shown in Fig. 6-8, relevant supplementary features of the present invention will be illustrated.
Referring to main claim, described " passage " 100 is defined as to the far-end 22 from optical fiber 3, emitting surface 13, in the direction of arrow X (Fig. 6 demonstration) extend until the passage of aperture plate 12 at least.Aperture plate 12 is arranged in to path 10 0 inside thus.End or path 10 0 that aperture plate 12 can limit path 10 0 also can continue at the nearside of aperture plate 12.
According to the present invention, laser catheter is provided with the narrowing portion in the described path 10 0 being arranged between emitting surface 13 and aperture plate 12.According to narrowing portion of the present invention, can be of different sizes and can be with many different modes settings.Fig. 6-8 show respectively the variant of different narrowing portion 110,120 and 130 separately.Narrowing portion is set to insert in Fig. 6-8, and it is mounted in the laser catheter of prior art.Yet, it should be noted that and also can expect another part of narrowing portion and conduit to form integral part, as holding device 9 or aperture plate 12.
Narrowing portion 110,120,130 has inward flange 111,121 and 131 separately, and it limits respectively the internal diameter of narrowing portion.Inward flange 131 has zigzag shape, shows that this internal diameter can be non-circular.Aperture plate element 12 has excircle 140.As seen in Fig. 6-8, narrowing portion 110,120 and 130 inward flange 111,121 and 131 all have the diameter of the diameter of the excircle 140 that is less than aperture plate element 12.In addition, in Fig. 6-8, can find out, described path 10 0 has the section 141 extending between narrowing portion 110,120,130 and aperture plate element, and the diameter of described section is greater than the internal diameter of described narrowing portion.
Referring to Fig. 6, narrowing portion 110 is that the circumferential rib by path 10 0 inside forms.This rib can be to comprise that by tubular body is machined into the integrated member of narrowing portion 110 and 112 obtains.Yet rib also can obtain in another way, for example-as shown in Figure 6---by ring 114 is inserted in path 10 0 and by ring 114 and is fixed to passage.Yet, it should be pointed out that rib 114 also can be fixed in passage by different way, for example, by means of the circumferential groove that has wherein engaged the channel interior of rib 114, or by means of rib 114 is engaged in to locking ridges therebetween.As can be seen in Figure 6, ring 114 has the external diameter of the internal diameter that approximates path 10 0, thereby can obtain clamping engagement.In the embodiment of Fig. 6, can further see, the section 141 of path 10 0 that extends and have the diameter of the internal diameter 114 that is greater than narrowing portion between narrowing portion 114 and aperture plate 12 can optionally extend in the whole distances between narrowing portion 110 and aperture plate 12.Rib/ring 114 forms a kind of inwall from path 10 0 at inward flange that radially inward direction extends.
Referring to Fig. 7, narrowing portion 120 is to be formed by the annular slab that is arranged on path 10 0 inside.This annular plate can obtain in a different manner, for example-and as shown in Figure 7-by the plate 124 with central perforation 125 is inserted in path 10 0 and by plate 124 and is fixed to passage.As seen in Fig. 7, plate 124 has the external diameter of the internal diameter that approximates path 10 0, thereby can obtain clamping engagement.Yet, it should be pointed out that plate 124 can also be fixed in passage by different way, for example, by means of the circumferential groove that has wherein engaged the outer peripheral channel interior of plate 124, or by means of the outward flange of plate 124 is engaged in to locking ridges therebetween.In the embodiment of Fig. 7, can also see, between narrowing portion 120 and aperture plate 12, extend and have the section 141 of path 10 0 of the diameter of the internal diameter 124 that is greater than narrowing portion, can in the whole distances between narrowing portion 114 and aperture plate 12, extend.Perforated plate 124 forms a kind of inwall from path 10 0 at inward flange that radially inward direction extends.
In the embodiment of Fig. 7, it can also be seen that, aperture plate element 12 is divided into interior section 126 and exterior section 127.The exterior section 127 of aperture plate element 12 is defined as, and when the far-end of conductive pipe on proximal direction P is observed, by the overlapping part of narrowing portion 120, in other words, exterior section 127 is arranged in the shade of narrowing portion 120.The interior section 126 of aperture plate element 12 is defined as, when the far-end of conductive pipe on proximal direction P is observed, be passed the overlapping part of path (perforation 125) of narrowing portion 120, in other words, interior section 126 is not arranged in the shade of narrowing portion 120 and by path 125, is visible when the far-end of conductive pipe is observed in the direction in arrow P.Effectively, this means, the surface of the interior section 126 of aperture plate element has the size identical with the surface of path 125 by narrowing portion 120.In this embodiment, grid hole 15 is arranged in the interior section 126 and exterior section 127 of aperture plate element 12.So-called lobe grid hole is arranged in exterior section 127 and guarantees that at any time suction force is all delivered to the space of the distal side of aperture plate element from the nearside of aperture plate element, because can not seal whole aperture plate mouths of the exterior section of aperture plate element 12.At least some grid holes will be at any time without lobe, even in the situation that lobe departs from target vascular completely or not exclusively.Grid hole 15 is arranged on and in interior section 126, allows the middle body of so-called lobe to be inhaled into aperture plate 12 to contact.
Embodiment shown in Fig. 8 is substantially identical with the embodiment shown in Fig. 7.Main difference is, the perforation 136 in the embodiment of Fig. 8 has and is different from circular cross section.The inward flange 131 of narrowing portion 130 is zigzags so that the tip pin 137 extending on inward direction to be radially provided.These tip pins provide the clamping to the improvement of so-called lobe.In the situation that so-called lobe possibly cannot be departed from from the wall of target vascular completely by laser action, when regaining conduit, the remnants between lobe and target vascular connect and can be ripped, it firmly fixes lobe with pin 137 together with.This is clamped to moving be further improved-be not presented in Fig. 8-when the tip of these pins is pointed to towards the direction P of aperture plate so that barb to be provided.
Referring to Fig. 6, Fig. 7 and 8, but only in Fig. 6, show, while observing in the axial direction, with the distance E on range transmission surface 13 with apart from the distance G of aperture plate 12, narrowing portion 110,120,130 is set, meanwhile, while observing in the axial direction, described narrowing portion has axial length F.As an example, according to embodiment of the present invention, the value of E, F and G is: E=0.13mm, F=0.15mm and G=0.12mm.It causes thus, B=0.4mm.In the present embodiment, path 10 0 has circular cross section, its (interior) diameter is 1.65-1.7mm, narrowing portion has the internal diameter 111,121,131 of 0.9mm, the external diameter of catheter tip (it is the external diameter of emitting surface 13 effectively) is about 2mm, and similarly in Fig. 7, grid hole 15 is present in the interior section 126 of aperture plate 12 and exterior section 127 in both.Yet it should be noted that this example is not intended to limit scope of the present invention, it is only intended to provide the size that can have according to conduit of the present invention and some sensations of size.The embodiment of this example is for comparative test.These tests disclose lobe rates from approximately 85% of prior art laser catheter, be increased to this example laser catheter surpass 98%.In these contrast tests, prior art laser catheter and be according to the unique difference between laser catheter of the present invention, prior art laser catheter does not have narrowing portion, and laser catheter according to the present invention has the narrowing portion described in this example simultaneously.In order to obtain comparative result, each test comprises that 55 arteriotomies with prior art laser catheter and 55 use the arteriotomy according to laser catheter of the present invention.
Although the inventor not exclusively determines the explanation to improved lobe rate, it is believed that explanation may be, use prior art laser catheter, if lobe is completely not separated with target vascular, the suction force of fixture (part) is malfunctioning, and use according to laser catheter of the present invention, kept this suction force of fixture.This will illustrate with further reference to Fig. 9, and it has shown prior art, and Figure 10 shows the present invention.These figure height schematically and only with cross section show aperture plate 12, optical fiber 3 far-end, target vascular 18 and-only Figure 10-demonstration is according to narrowing portion 200 of the present invention.In addition, arrow S represents the suction force of fixture.Shall also be noted that the distance B in these tests is about 0.4mm, and although schematic diagram can be pointed out in addition, the thickness of the wall of target vascular 18, and therefore also have the thickness of lobe 19, is about 0.3mm,, approaches the size apart from B that is.
Fig. 9 A has shown the prior art laser catheter during laser action, afterwards any separation of lobe 19.Suction force S (in distally of aperture plate 12) in path 10 0 produces decompression, described decompression towards, similarly facing to aperture plate 12 suction lobes 19.When laser action is when the wall by target vascular has burnt annular channels, during the wall part of lobe 19-be positioned at annular channels inside-will regain conduit with box lunch facing to aperture plate suction, fixture keeps it.Subsequently, for the existence of lobe, can check conduit.If lobe is present on aperture plate, arteriotomy classifies as successfully.If lobe does not exist, arteriotomy classifies as unsuccessful.The arteriotomy that is not whole prior aries looks it is successful.Success rate appears as approximately 85%.
Inventor's hypothesis, in practice, during laser action, does not always all around complete in the identical time at lobe from the annular channels of burning-off around lobe 19 constantly.By inference, in practice, generation, annular channels is such to finish precedent as 80%, still leaves 20% lobe circumference and is attached to target vascular 18.When this occurs, a part for the lobe 19 that part is separated will be facing to aperture plate 12 suctions, and the part that leaves aperture plate 12 is dissociated, referring to the left side of Fig. 9 B.Therefore, aperture plate 12 is completely not overlapping by lobe.Such result is that to become not too effectively may be maybe invalid to suction force S.This is illustrated in Fig. 9 B by virtualization arrow S.Overlapping aperture plate 12 is not promoted by circumference in this case similarly completely, and during laser action, lobe is under elasticity tension.Partly divide polypetalous to cause elastic shrinkage, at it, be still attached to tractive lobe in the direction of position of wall of target vascular 18, cause the bad contact between distally fiber point/emitting surface 22 and remaining lobe, and therefore prevent effective ablation process.
Turn to now according to laser catheter of the present invention, Figure 10 A has shown the situation same with Fig. 9 A.Under laser action, suction force is facing to fixture suction lobe 19.The size of considering narrowing portion 200, the thickness of path 10 0 and lobe 19, it is believed that to be, similarly, lobe will be given prominence to and lean against aperture plate 12 from narrowing portion 200.
In about identical time, constantly complete at lobe 19 around burning-off annular channels in the situation that, it is believed that the situation about showing in Fig. 9 B of having occurred.This situation and prior art are roughly the same, although it is believed that due to facing to the inward flange 201 tractive lobes of narrowing portion 200, make the inward flange 201 of narrowing portion with at the combined holding action that improved of the dominant decompression in 210 places.
At lobe 19, not exclusively from the separation of target vascular in the situation that, it is believed that the situation that Figure 10 C occurs.Again for example, suppose will lobe 19 around the annular channels of burning-off complete 80%, the circumference that leaves 20% lobe is attached to transplanting vascular.The whole inward flange 201 of narrowing portion 200 is bonded on lobe, to keep, in the part of path 10 0 for the decompression at the nearside place of narrowing portion-between narrowing portion 200 and aperture plate 12, likely keeps completely.So suction force S remains effectively and holding action can not reduce.In addition, it is believed that the tension force on lobe 19,, by residual 20% position of the annular channels of burning-off, maintain certain level, so that burning still of laser can continue effectively.In addition, it is believed that same in the situation that do not continue on for remaining 20% will be by the laser action of the path of burning-off, due to improved holding action, the passage of these remnants 20% only can be by ripping it to produce.In this respect, it should be pointed out that holding action can improve by tip pin (as in Fig. 8) is set, described tip pin can optionally form barb.
The present invention can also be expressed as represented with following clause:
1) for the laser catheter of by-pass operation,
Wherein laser catheter comprises:
-comprising the tubulose layout of the optical fiber tubulose bundle with the far-end that limits emitting surface, described emitting surface is for Emission Lasers radiation in the distal direction of described conduit;
-at the far-end of described conduit, the passage that the inside that extends upward and arranged by described tubulose at the axle of described laser catheter limits, described passage can be connected to suction source;
-to be adjacent to described emitting surface certain distance, being arranged on the aperture plate element of described channel interior, described aperture plate element is being crossed over the extension in a lateral direction of the conduit of described passage;
Wherein said laser catheter also comprises the narrowing portion that is arranged on described channel interior, and described conduit axially on while observing, described narrowing portion is between described emitting surface and described aperture plate element; The internal diameter of wherein said narrowing portion is less than the external diameter of described aperture plate element; With
The section of the passage wherein extending between described narrowing portion and described aperture plate element has the diameter of the internal diameter that is greater than narrowing portion.
2), according to the laser catheter of clause 1, wherein said section extends until described aperture plate element from described narrowing portion.
3) according to the laser catheter of in aforementioned clause, wherein described aperture plate element is divided into interior section and exterior section; The exterior section of wherein said aperture plate element is defined as, when observing to the far-end of described conduit in proximal direction by the overlapping part of described narrowing portion; And wherein the interior section of described aperture plate element is defined as, when observing to the far-end of described conduit in proximal direction by the overlapping part of the path by described narrowing portion.
4), according to the laser catheter of clause 3, the interior section of wherein said aperture plate element is provided with grid hole.
5), according to the laser catheter of clause 3 or 4, the exterior section of wherein said aperture plate element is provided with grid hole.
6) according to the laser catheter of in aforementioned clause, the inward flange of wherein said narrowing portion is provided with tip pin, and as tip sawtooth, described tip pin is radially extending on inward direction.
7), according to the laser catheter of clause 6, wherein direction towards aperture plate is pointed to so that agnail to be provided in the tip of these pins.
8) according to the laser catheter of in aforementioned clause, the internal diameter of wherein said narrowing portion is described channel diameter at the most 80%, such as at the most 70% or at the most 60%.
9) according to the laser catheter of in aforementioned clause, the internal diameter of wherein said narrowing portion is described channel diameter at least 30%, such as at least 40% or at least 45%.
10), according to the laser catheter of in aforementioned clause, the internal diameter of wherein said narrowing portion is in 30% to 80% scope of described channel diameter, in 40% to 60% scope.
11) according to the laser catheter of in aforementioned clause, wherein, while observing in the axial direction, the distance from described narrowing portion to described emitting surface is 0% to 60% of the distance from described aperture plate element to described emitting surface, in 20% to 45% scope.
12), according to the laser catheter of in aforementioned clause, wherein, while observing in the axial direction, the axial length of described narrowing portion is in 25% to 50% scope of the distance from described aperture plate element to described emitting surface, in the scope 35% to 40%.
13) according to the laser catheter of in aforementioned clause, wherein, while observing in the axial direction, the distance from described narrowing portion to described emitting surface the internal diameter of described emitting surface 0% to 15% such as 4% to 12% scope in.
14) according to the laser catheter of in aforementioned clause, wherein, while observing in the axial direction, the distance from described narrowing portion to described emitting surface is 0.07mm at least, such as 0.1mm at least.
15) according to the laser catheter of in aforementioned clause, wherein, while observing in the axial direction, the distance from described narrowing portion to described emitting surface is 0.4mm at the most, such as 0.25mm at the most.
16) according to the laser catheter of in clause 14-15, wherein, while observing in the axial direction, the distance from described aperture plate element to described emitting surface is 0.25mm at least, such as 0.35mm at least.
17) according to the laser catheter of in clause 14-16, wherein, while observing in the axial direction, the distance from described aperture plate element to described emitting surface is 0.6mm at the most, such as 0.5mm at the most.
18) according to the laser catheter of in aforementioned clause, wherein, while observing in the axial direction, the distance from described aperture plate element to described narrowing portion is 0.04mm at least, such as 0.08mm at least.
19), according to the laser catheter of in aforementioned clause, wherein, while observing in the axial direction, the distance from described aperture plate element to described narrowing portion is 0.5mm at the most, such as 0.4mm or at the most 0.3mm at the most.
20), according to the laser catheter of in aforementioned clause, wherein said conduit also comprises, at the far-end of described conduit with on the outside of described tubulose layout, expands the stop element of conduit girth with respect to fibre bundle.
21) molectron, described molectron comprises:
-according to the laser catheter of in aforementioned clause; With
-ring element;
Wherein, the diameter of described ring element is greater than the diameter of the far-end of described tubulose layout.
22) molectron, described molectron comprises:
-according to the laser catheter of in aforementioned clause 1-20; With
-transplant vascular, described transplanting vascular has the described laser catheter of permission by the diameter dimension of described transplanting vascular.
23) according to the molectron of clause 22, wherein said molectron also comprises ring element, described ring element has the diameter of the diameter of the far-end that is greater than described tubulose layout, and wherein said transplanting vascular has the diameter dimension that allows described transplanting vascular to insert by described ring element.
24), according to the molectron of in clause 22-23, insert by described ring element and wherein said transplanting vascular and transplant angle between the fold back portion of vascular in the scope of 90 to 180 degree one end of wherein said transplanting vascular.
25), according to the molectron of in clause 22-24, wherein said transplanting vascular is artificial transplanting vascular.
26) according to the molectron of in clause 22-25, wherein said transplanting vascular is biological vascular.
27) according to the molectron of in clause 22-26, wherein said transplanting vascular is from human body or animal body separation.
28) according to the molectron of in clause 22-27, wherein said molectron also comprises the suction source that can be connected to or be connected to described passage.
29) molectron, described molectron comprises:
-according to the laser catheter of in aforementioned clause 1-20; With
-can be connected to or be connected to the suction source of described passage.
30) according to the molectron of in clause 21-29, wherein said molectron also comprises excimer laser source, and it can be coupled to for the laser energy being produced by described lasing light emitter being sent to the laser catheter of the optical fiber of described laser catheter.
31) molectron, described molectron comprises:
-according to the laser catheter of in aforementioned clause 1-20; With
-excimer laser source, it can be coupled to for the laser energy being produced by described lasing light emitter being sent to the laser catheter of the optical fiber of described laser catheter.
32) manufacture the method for the laser catheter of by-pass operation, described laser catheter comprises:
-comprising the tubulose layout of the optical fiber tubulose bundle with the far-end that limits emitting surface, described emitting surface is for Emission Lasers radiation in the distal direction of described conduit;
-at the far-end of described conduit, the passage that the inside that extends upward and arranged by described tubulose at the axle of described laser catheter limits, described passage can be connected to suction source;
-to be adjacent to described emitting surface certain distance, being arranged on the aperture plate element of described channel interior, described aperture plate element is being crossed over the extension in a lateral direction of the conduit of described passage;
Wherein said method comprises, described conduit axially on while observing, between described emitting surface and described aperture plate element, the step of the narrowing portion of channel interior is set, described narrowing portion has the internal diameter of the external diameter that is less than described aperture plate element, and the section of the passage wherein extending between described narrowing portion and described aperture plate element has the diameter of the internal diameter that is greater than described narrowing portion.
33), according to the method for clause 32, wherein according to one or more in clause 2-20, described narrowing portion is set.
34) transplanting vascular is connected to the method for target vascular, said method comprising the steps of:
-far-end of described transplanting vascular is connected to the sidewall of described target vascular;
-will be inserted in the inner chamber of described transplanting vascular according to the laser catheter of in clause 1-20;
-after described Connection Step, with described laser catheter, on the sidewall of described target vascular, burn annular opening;
-described burn step during or after, by the described passage of described laser catheter is applied to suction force, clamp lobe, described lobe is defined as the wall part of the annular opening inside that being positioned at of target vascular burnt;
-when continuing described clamping step and described burn step after, by regaining described laser catheter in the proximal direction at described transplanting vascular, from described transplanting vascular, remove described laser catheter.
As being clearly, many variants of the present invention can imagined in the scope of the invention as defined in the claims.
Claims (34)
1. for the laser catheter of by-pass operation,
Wherein said laser catheter comprises:
The tubulose layout that comprises the optical fiber tubulose bundle with the far-end that limits emitting surface, described emitting surface is for Emission Lasers radiation in the distal direction of described conduit;
At the far-end of described conduit, the passage that the inside that extends upward and arranged by described tubulose at the axle of described laser catheter limits, described passage can be connected to suction source;
To be adjacent to described emitting surface certain distance, be arranged on the aperture plate element of described channel interior, described aperture plate element is being crossed over the extension in a lateral direction of the conduit of described passage;
Be characterised in that,
Described laser catheter also comprises the narrowing portion that is arranged on described channel interior, and described conduit axially on while observing, described narrowing portion is between described emitting surface and described aperture plate element;
The internal diameter of described narrowing portion is less than the external diameter of described aperture plate element, and
The section of the passage extending between described narrowing portion and described aperture plate element has the diameter of the internal diameter that is greater than narrowing portion.
2. according to the laser catheter of claim 1, wherein said section extends until described aperture plate element from described narrowing portion.
3. according to the laser catheter of in aforementioned claim, wherein described aperture plate element is divided into interior section and exterior section; The exterior section of wherein said aperture plate element is defined as, when observing to the far-end of described conduit in proximal direction by the overlapping part of described narrowing portion; And wherein the interior section of described aperture plate element is defined as, when observing to the far-end of described conduit in proximal direction by the overlapping part of the path by described narrowing portion.
4. according to the laser catheter of claim 3, the interior section of wherein said aperture plate element is provided with grid hole.
5. according to the laser catheter of claim 3 or 4, the exterior section of wherein said aperture plate element is provided with grid hole.
6. according to the laser catheter of in aforementioned claim, the inward flange of wherein said narrowing portion is provided with tip pin, resembles tip sawtooth, and described tip pin is radially extending on inward direction.
7. according to the laser catheter of claim 6, wherein direction towards described aperture plate is pointed to so that agnail to be provided in the tip of these pins.
8. according to the laser catheter of in aforementioned claim, the internal diameter of wherein said narrowing portion is described channel diameter at the most 80%, such as at the most 70% or at the most 60%.
9. according to the laser catheter of in aforementioned claim, the internal diameter of wherein said narrowing portion is described channel diameter at least 30%, such as at least 40% or at least 45%.
10. according to the laser catheter of in aforementioned claim, the internal diameter of wherein said narrowing portion is in 30% to 80% scope of described channel diameter, in 40% to 60% scope.
11. according to the laser catheter of in aforementioned claim, wherein, while observing in the axial direction, the distance from described narrowing portion to described emitting surface is 0% to 60% of the distance from described aperture plate element to described emitting surface, in 20% to 45% scope.
12. according to the laser catheter of in aforementioned claim, and wherein, while observing in the axial direction, the axial length of described narrowing portion is in 25% to 50% scope of the distance from described aperture plate element to described emitting surface, in the scope 35% to 40%.
13. according to the laser catheter of in aforementioned claim, and wherein, while observing in the axial direction, the distance from described narrowing portion to described emitting surface is 0% to 15% of the internal diameter of described emitting surface, in 4% to 12% scope.
14. according to the laser catheter of in aforementioned claim, and wherein, while observing in the axial direction, the distance from described narrowing portion to described emitting surface is 0.07mm at least, such as 0.1mm at least.
15. according to the laser catheter of in aforementioned claim, and wherein, while observing in the axial direction, the distance from described narrowing portion to described emitting surface is 0.4mm at the most, such as 0.25mm at the most.
16. according to the laser catheter of in claim 14-15, and wherein, while observing in the axial direction, the distance from described aperture plate element to described emitting surface is 0.25mm at least, such as 0.35mm at least.
17. according to the laser catheter of in claim 14-16, and wherein, while observing in the axial direction, the distance from described aperture plate element to described emitting surface is 0.6mm at the most, such as 0.5mm at the most.
18. according to the laser catheter of in aforementioned claim, and wherein, while observing in the axial direction, the distance from described aperture plate element to described narrowing portion is 0.04mm at least, such as 0.08mm at least.
19. according to the laser catheter of in aforementioned claim, and wherein, while observing in the axial direction, the distance from described aperture plate element to described narrowing portion is 0.5mm at the most, such as 0.4mm or at the most 0.3mm at the most.
20. according to the laser catheter of in aforementioned claim, and wherein said conduit also comprises, at the far-end of described conduit with on described tubulose layout outside, expands the stop element of conduit girth with respect to fibre bundle.
21. molectrons, described molectron comprises:
According to the laser catheter of in aforementioned claim; With
Ring element;
Wherein, the diameter of described ring element is greater than the diameter of the far-end of described tubulose layout.
22. molectrons, described molectron comprises:
According to the laser catheter of in aforementioned claim 1-20; With
Transplant vascular, described transplanting vascular has the described laser catheter of permission by the diameter dimension of described transplanting vascular.
23. according to the molectron of claim 22, wherein said molectron also comprises ring element, described ring element has the diameter of the diameter of the far-end that is greater than described tubulose layout, and wherein said transplanting vascular has the diameter dimension that allows described transplanting vascular to insert by described ring element.
24. according to the molectron of in claim 22-23, and insert by described ring element and wherein said transplanting vascular and transplant angle between the fold back portion of vascular in the scope of 90 to 180 degree one end of wherein said transplanting vascular.
25. according to the molectron of in claim 22-24, and wherein said transplanting vascular is artificial transplanting vascular.
26. according to the molectron of in claim 22-25, and wherein said transplanting vascular is biological vascular.
27. according to the molectron of in claim 22-26, and wherein said transplanting vascular is from human body or animal body separation.
28. according to the molectron of in claim 22-27, and wherein said molectron also comprises the suction source that can be connected to or be connected to described passage.
29. molectrons, described molectron comprises:
According to the laser catheter of in aforementioned claim 1-20; With
Can be connected to or be connected to the suction source of described passage.
30. according to the molectron of in claim 21-29, and wherein said molectron also comprises excimer laser source, and it can be coupled to for the laser energy being produced by described lasing light emitter being sent to the laser catheter of the optical fiber of described laser catheter.
31. molectrons, described molectron comprises:
According to the laser catheter of in aforementioned claim 1-20; With
Excimer laser source, it can be coupled to for the laser energy being produced by described lasing light emitter being sent to the laser catheter of the optical fiber of described laser catheter.
32. manufacture the method for the laser catheter of by-pass operation, and described laser catheter comprises:
The tubulose layout that comprises the optical fiber tubulose bundle with the far-end that limits emitting surface, described emitting surface is for Emission Lasers radiation in the distal direction of described conduit;
At the far-end of described conduit, the passage that the inside that extends upward and arranged by described tubulose at the axle of described laser catheter limits, described passage can be connected to suction source;
To be adjacent to described emitting surface certain distance, be arranged on the aperture plate element of described channel interior, described aperture plate element is being crossed over the extension in a lateral direction of the conduit of described passage;
Wherein said method comprises, described conduit axially on while observing, between described emitting surface and described aperture plate element, be arranged on the step of the narrowing portion of described channel interior, described narrowing portion has the internal diameter of the external diameter that is less than described aperture plate element; And the section of the passage wherein extending between described narrowing portion and described aperture plate element has the diameter of the internal diameter that is greater than described narrowing portion.
33. according to the method for claim 32, wherein according to one or more in claim 2-20, described narrowing portion is set.
34. will transplant vascular and be connected to the method for target vascular, said method comprising the steps of:
The far-end of described transplanting vascular is connected to the sidewall of described target vascular;
To be inserted in the inner chamber of described transplanting vascular according to the laser catheter of in claim 1-20;
After described Connection Step, with described laser catheter, on the sidewall of described target vascular, burn annular opening;
Described burn step during or after, by the described passage of described laser catheter is applied to suction force, clamp lobe, described lobe is defined as the wall part of the annular opening inside that being positioned at of target vascular burnt;
When continuing described clamping step and described burn step after, by regaining described laser catheter in the proximal direction at described transplanting vascular, from described transplanting vascular, remove described laser catheter.
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/NL2011/050444 WO2012177117A1 (en) | 2011-06-21 | 2011-06-21 | Laser catheter for bypass surgery, as well as assembly comprising such a catheter |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN103747758A true CN103747758A (en) | 2014-04-23 |
Family
ID=44628051
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201180072998.0A Pending CN103747758A (en) | 2011-06-21 | 2011-06-21 | Laser catheter for bypass surgery, as well as assembly comprising such a catheter |
Country Status (5)
| Country | Link |
|---|---|
| US (1) | US20140200565A1 (en) |
| EP (1) | EP2723266B1 (en) |
| JP (1) | JP5681864B2 (en) |
| CN (1) | CN103747758A (en) |
| WO (1) | WO2012177117A1 (en) |
Families Citing this family (19)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US9028520B2 (en) | 2006-12-22 | 2015-05-12 | The Spectranetics Corporation | Tissue separating systems and methods |
| US8961551B2 (en) | 2006-12-22 | 2015-02-24 | The Spectranetics Corporation | Retractable separating systems and methods |
| US9763692B2 (en) | 2012-09-14 | 2017-09-19 | The Spectranetics Corporation | Tissue slitting methods and systems |
| US9291663B2 (en) | 2013-03-13 | 2016-03-22 | The Spectranetics Corporation | Alarm for lead insulation abnormality |
| US9283040B2 (en) | 2013-03-13 | 2016-03-15 | The Spectranetics Corporation | Device and method of ablative cutting with helical tip |
| US9883885B2 (en) | 2013-03-13 | 2018-02-06 | The Spectranetics Corporation | System and method of ablative cutting and pulsed vacuum aspiration |
| US9456872B2 (en) | 2013-03-13 | 2016-10-04 | The Spectranetics Corporation | Laser ablation catheter |
| US10383691B2 (en) | 2013-03-13 | 2019-08-20 | The Spectranetics Corporation | Last catheter with helical internal lumen |
| US10835279B2 (en) | 2013-03-14 | 2020-11-17 | Spectranetics Llc | Distal end supported tissue slitting apparatus |
| US10842532B2 (en) | 2013-03-15 | 2020-11-24 | Spectranetics Llc | Medical device for removing an implanted object |
| US9668765B2 (en) | 2013-03-15 | 2017-06-06 | The Spectranetics Corporation | Retractable blade for lead removal device |
| US10448999B2 (en) | 2013-03-15 | 2019-10-22 | The Spectranetics Corporation | Surgical instrument for removing an implanted object |
| WO2014151814A1 (en) | 2013-03-15 | 2014-09-25 | The Spectranetics Corporation | Surgical instrument for removing an implanted object |
| WO2017048486A1 (en) | 2013-03-15 | 2017-03-23 | The Spectranetics Corporation | Medical device for removing an implanted object using laser cut hypotubes |
| US9918737B2 (en) | 2013-03-15 | 2018-03-20 | The Spectranetics Corporation | Medical device for removing an implanted object |
| WO2015134383A1 (en) | 2014-03-03 | 2015-09-11 | The Spectranetics Corporation | Multiple configuration surgical cutting device |
| US10405924B2 (en) | 2014-05-30 | 2019-09-10 | The Spectranetics Corporation | System and method of ablative cutting and vacuum aspiration through primary orifice and auxiliary side port |
| USD770616S1 (en) | 2015-02-20 | 2016-11-01 | The Spectranetics Corporation | Medical device handle |
| USD765243S1 (en) | 2015-02-20 | 2016-08-30 | The Spectranetics Corporation | Medical device handle |
Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP0750476B1 (en) * | 1994-03-15 | 1999-06-02 | MEDOLAS Gesellschaft für Medizintechnik | Laser catheter for bypass surgery |
| EP1967152A1 (en) * | 2007-03-05 | 2008-09-10 | Frank Michael Münker | Device for creating openings in pressurized vessels with deformable walls |
| CN101977554A (en) * | 2008-04-03 | 2011-02-16 | Amj公司 | Securing device and assembly comprising such a securing device |
| WO2011031131A1 (en) * | 2009-09-11 | 2011-03-17 | Amj B.V. | A catheter system for bypass surgery and a method for preparing a catheter system for bypass surgery |
-
2011
- 2011-06-21 WO PCT/NL2011/050444 patent/WO2012177117A1/en active Application Filing
- 2011-06-21 EP EP11730094.7A patent/EP2723266B1/en active Active
- 2011-06-21 JP JP2014516937A patent/JP5681864B2/en active Active
- 2011-06-21 US US14/124,214 patent/US20140200565A1/en not_active Abandoned
- 2011-06-21 CN CN201180072998.0A patent/CN103747758A/en active Pending
Patent Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP0750476B1 (en) * | 1994-03-15 | 1999-06-02 | MEDOLAS Gesellschaft für Medizintechnik | Laser catheter for bypass surgery |
| EP1967152A1 (en) * | 2007-03-05 | 2008-09-10 | Frank Michael Münker | Device for creating openings in pressurized vessels with deformable walls |
| CN101977554A (en) * | 2008-04-03 | 2011-02-16 | Amj公司 | Securing device and assembly comprising such a securing device |
| WO2011031131A1 (en) * | 2009-09-11 | 2011-03-17 | Amj B.V. | A catheter system for bypass surgery and a method for preparing a catheter system for bypass surgery |
Also Published As
| Publication number | Publication date |
|---|---|
| EP2723266B1 (en) | 2016-03-09 |
| US20140200565A1 (en) | 2014-07-17 |
| JP5681864B2 (en) | 2015-03-11 |
| EP2723266A1 (en) | 2014-04-30 |
| JP2014524782A (en) | 2014-09-25 |
| WO2012177117A1 (en) | 2012-12-27 |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| CN103747758A (en) | Laser catheter for bypass surgery, as well as assembly comprising such a catheter | |
| CN106572866B (en) | Coring expander for the well-defining in tissue wall | |
| US8273078B2 (en) | Device for creating openings in pressurized vessels with deformable walls | |
| US8734436B2 (en) | Laser catheter for bypass surgery and assembly comprising said catheter | |
| RU2377958C2 (en) | Apparatus and method for treating varicose veins | |
| US20110301620A1 (en) | Device for suturing two hollow biological tissues | |
| KR101668663B1 (en) | The kit which using a stitching fiber and method thereof | |
| US20210068837A1 (en) | Connector and wrap for end-to-side nerve coaptation | |
| US7150742B2 (en) | Graft grasping device | |
| JPH10500036A (en) | Bypass surgical laser catheter | |
| EP2265191B1 (en) | Securing device and assembly comprising such a securing device | |
| US20090105545A1 (en) | Apparatus and method for facilitating the implantation of a medical device | |
| JPH0761335B2 (en) | Adjustable endoluminal valve dissector | |
| CN101947117B (en) | Side-falling nail-supporting seat components and anastomat using side-falling nail seat components | |
| KR102320419B1 (en) | Endoloop with multiple loops | |
| CN203597993U (en) | Assembly of graft vessel and anastomosis connector | |
| KR101747126B1 (en) | A vascular anastomosis device having a blood vessel clamping structure | |
| KR101189560B1 (en) | Suture with needle | |
| JPS62266044A (en) | Take-out type anastomosis tool for surgical operation | |
| SU835427A1 (en) | D.v.usov's method of anastomosis of pancreas stump with hollow organ | |
| NZ739943B2 (en) | Device to aid in arterial microvascular anastomosis | |
| JP2016116578A (en) | Artificial blood vessel |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| C06 | Publication | ||
| PB01 | Publication | ||
| C10 | Entry into substantive examination | ||
| SE01 | Entry into force of request for substantive examination | ||
| ASS | Succession or assignment of patent right |
Owner name: KEWA SIKE MEDICAL COMPANY Free format text: FORMER OWNER: C DE ZHONG Effective date: 20140912 Owner name: C DE ZHONG Free format text: FORMER OWNER: AMJ B. V. Effective date: 20140912 |
|
| C41 | Transfer of patent application or patent right or utility model | ||
| TA01 | Transfer of patent application right |
Effective date of registration: 20140912 Address after: Utrecht Applicant after: Medical Co. Address before: Utrecht Applicant before: C Dezhong Effective date of registration: 20140912 Address after: Utrecht Applicant after: C Dezhong Address before: Utrecht Applicant before: AMJ B.V. |
|
| C02 | Deemed withdrawal of patent application after publication (patent law 2001) | ||
| WD01 | Invention patent application deemed withdrawn after publication |
Application publication date: 20140423 |